Necroses dos maxilares associadas ao tratamento oncológico: uma revisão narrativa da literatura
DOI:
https://doi.org/10.5335/rfo.v31i1.18328Palavras-chave:
Osteorradionecrose, Neoplasias de cabeça e pescoço, Osteonecrose associada a bifosfonatos, Diagnóstico diferencialResumo
Objetivo: Discutir aspectos diferenciais clínicos, imaginológicos e relativos ao manejo da ONMRM e da ORNM. Revisão de literatura: As necroses ósseas são condições caracterizadas pela morte do tecido ósseo devido à interrupção do suprimento sanguíneo local e pode ser induzida por um trauma, radiação, uso de medicações e infecção. Frente ao tratamento antineoplásico, necroses ósseas podem se desenvolver nos maxilares como complicações graves: a osteonecrose dos maxilares relacionada medicamentos (ONMRM), e a osteorradionecrose dos maxilares (ORNM). As duas condições estudadas possuem fatores etiológicos distintos, embora compartilhem manifestações clínicas semelhantes. A ORNM apresenta maior incidência na mandíbula e está associada ao maior risco de fraturas patológicas. Radiograficamente, a ORNM tende a se manifestar em áreas irradiadas, com margens difusas e geralmente sem reação periosteal evidente, enquanto a ONMRM pode ter limites mais bem delineados e aposição óssea subperiosteal. A ONMRM geralmente apresenta melhor resposta ao tratamento conservador, comparado a ORNM, que frequentemente requer ressecções cirúrgicas extensas. Considerações finais: ONMRM e ORNM representam complicações graves decorrentes do tratamento oncológico e diagnosticá-las corretamente é essencial para um manejo preventivo e curativo eficaz.
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